Angiology最新文献

Frozen elephant trunk (FET) has gained popularity since its inception. Nevertheless, the optimal approach for managing aortic arch pathologies remains subject of debate. This meta-analysis compared outcomes between patients undergoing FET and those undergoing conventional aortic repair. Systematic searches were conducted up to February 2024. Pooled results of short and long-term outcomes were computed. A systematic review identified 21 non-randomized studies encompassing 3240 patients. Short-term mortality was lower in FET recipients than in those undergoing conventional repair (OR [95% CI] = 0.58 [0.44-0.78], P < .01). Postoperative paraplegia incidence was higher in the FET cohort (OR = 1.85 [1.02-3.34], P = .04), while subgroup analysis showed no difference between the two groups in patients with acute aortic dissection. Long-term all-cause mortality was lower among FET recipients. Subgroup analysis showed FET was associated with reduced all-cause mortality (HR = 0.55 [0.39-0.79], P < .01) and aortic re-intervention (HR = 0.62 [0.39-0.99], P = .05) in acute aortic dissection patients. This meta-analysis underscores the favorable association between the utilization of FET and improved short and long-term outcomes compared with conventional repair, while paraplegia incidence was higher in the FET group. FET appears to offer superior benefits, particularly evident in patients with acute aortic dissection.

Severe left main coronary artery (LMCA) lesions (≥50% stenosis) portend a poor prognosis and require urgent revascularization. In this study, we identified the incidence and clinical predictors of severe LMCA stenosis in patients with chronic coronary syndrome (CCS) who had undergone coronary angiography for the first time. Using a nationwide database registry, all the patients with CCS who had undergone coronary angiography were included. Patients were classified based on having severe LMCA stenosis and they were compared based on the recommended therapeutic strategy after angiography. A multivariable binary logistic regression model was developed to identify the potential predictors of a severe LMCA lesion. Among 40,161 patients with CCS, a severe LMCA lesion was detected in a total of 1556 participants (3.87% [3.69; 6.07]). The multivariable logistic regression identified age (odds ratio [OR]: 1.04 [1.03;1.04]), male gender (OR:2.56 [2.28; 2.89]), dyslipidemia (OR:1.19 [1.06; 1.34]), and peripheral arterial disease (PAD) (OR:3.68 [1.06;12.83]) as predictors of a severe LMCA stenosis. Approximately 4% of patients with newly diagnosed CCS may suffer from severe LMCA disease. Age, male gender, dyslipidemia, and PAD are among the predicting factors of a severe LMCA stenosis and can be utilized in risk stratification of patients with CCS at greater risk of severe LMCA stenosis.

The aim of this review was to perform a critical appraisal of serum inflammatory biomarkers used for the prediction of cardiovascular disease (CVD) risk. We conducted a systematic review of studies listed on MEDLINE and Scopus from January 2000 to December 2023, focused on the prognostic value of serum inflammatory biomarkers [i.e., C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)] in individuals without known CVD. Eligible studies used a multivariate prediction model and included discrimination or risk reclassification analysis. The Quality in Prognostic Studies (QUIPS) tool was used to evaluate study quality and potential bias. Thirty-five studies (i.e., total 208,897 participants) that evaluated the added prognostic value of CRP, IL-6, TNF-α on CVD risk prediction were retrieved. Significant improvements in CVD risk model's predictive ability were observed in 7 out of 32 studies relating CRP and 1 out of 8 studies relating IL-6 with CVD risk. The single study found no added prognostic value of TNF-α use in CVD risk model. The integration of serum inflammatory biomarkers into CVD risk prediction models does not appear to improve risk discrimination models, suggesting that these biomarkers may act as surrogate markers, but not as predictors of atherosclerotic CVD.

While multiple scoring systems exist to predict mortality in cardiac surgery, their utility in infective endocarditis (IE) remains uncertain, prompting this study to compare their prognostic accuracy. We conducted a comprehensive review using Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials. Data were pooled using Open-Meta[Analyst] software, and calibration analysis was performed with Review Manager 5.4. Among 620 articles identified, 570 were screened, leading to 15 included studies. Twelve risk scores were analyzed for operative mortality discrimination in IE surgery, with the area under the curve (AUC) ranging from 0.64 to 0.83. Among the IE-specific risk scores, AUCs (95% confidence interval) were highest for ANCLA (Anemia, NYHA class IV, critical state, large intracardiac destruction, surgery on thoracic aorta) 0.838 (0.803-0.873), AEPEI (Association pour l'Etude et la Prevention de l'Endocadite Infectieuse) 0.764 (0.726-0.802), RISK-E (Risk Endocarditis) (0.752 (0.662-0.842) and APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa) 0.750 (0.726-0.774) scores. Regarding traditional risk scores, EuroSCORE II performed at 0.750 (0.725-0.775) but underestimated mortality compared with EuroSCORE I in calibration analysis. In conclusion, EuroSCORE II and several endocarditis-specific scores had moderate discrimination (AUC > 0.75) in predicting mortality after IE surgery.

Atherosclerosis often starts in childhood, tracking to adulthood. In children, early vascular disease can be detected as arterial stiffness. Carotid-femoral pulse wave velocity is considered the non-invasive gold standard method for measuring arterial stiffness and widely accepted for use in children. We define pulse wave velocity (PWV) reference values for African children, in a cohort of children and adolescents living in Cape Town, South Africa, using the oscillometric Vicorder device, and considering the anatomical pathway in growing children. Three hundred and twenty four children (6-16 years old) were followed annually at Tygerberg Hospital, from March 2014 to March 2020, yielding 959 longitudinal PWV measurements. Centile curves for males and females by age and height were constructed using the Lamda-Mu-Sigma (LMS) method. Our study demonstrates that African children have a relatively flat PWV throughout childhood and early adolescence, from 7 to 14 years of age, and between 120 and 170 cm standing height. These gender-specific percentiles for age and height will allow accurate surveillance of arterial elasticity in African children over time. The identification of children at high risk is important given the long-term health implications and the effectiveness of early intervention to prevent progression to cardiovascular disease.